Expanding VA adjusts to needs of returning veterans
Improvements to care for women veterans a priority
Friday, December 11, 20091
2
3
4
5
NORTHAMPTON - Eight years of deployments in the global war on terror and the physical and psychological wounds that military service has inflicted on tens of thousands of American soldiers are placing new demands on the country's health-care network for veterans.
The U.S. Department of Veterans Affairs Medical Center in Leeds, where transformations in patient care are under way, is no exception.
In recent years, the medical center has hired dozens of additional staff members in mental health services, including psychologists and social workers, implemented a new care management program for veterans returning from Iraq and Afghanistan and launched a more comprehensive women veterans health program, among other initiatives.
The changes, many of them federally mandated, come at a time of increasing service demands fueled by Operations Iraqi Freedom and Enduring Freedom - and amid continued calls for reforms and improvements in the way the government administers health-care services for veterans.
"We've improved, we've expanded, we've adjusted to the needs of patients," said Dr. Gonzalo Vera, director of mental health services at the VA medical center. "While the reasons for it are sad, it's a very exciting time to be a clinician in the VA. No one else out there has more experience and understanding of their experiences than we do."
Last year alone, the medical center served nearly 14,000 patients from western Massachusetts, including 673 veterans returning from Iraq and Afghanistan, many of them women.
Plugging in
Among those helping bring these veterans in to the VA health system is Sheila M. Davies, a licensed social worker and manager of a relatively new VA program that provides outreach, enrollment and care management services to veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Those are the official government terms used for the military campaigns in Iraq and Afghanistan, among other U.S. operations supporting the global war on terror.
As of this fall, the program, mandated in November 2007 at all VA medical centers, helped enroll 1,900 area veterans who have served in combat zones since 1998. Under the program's guidelines, these veterans have five years to enroll for free care from the date of separation from active duty, and are eligible for all VA services related to their combat experience regardless if there is sufficient evidence to link medical conditions to that service.
"It's really, really critical for returning combat veterans to enroll while they have the eligibility," Davies said. "We help plug them in."
The program is designed to ensure returning combat veterans know about and are provided timely access to the services available to them, Davies said.
"We try to make sure they (veterans) are assessed thoroughly for all the problems they may have," Davies said. "We try to schedule them the same day for a medical appointment."
Those initial assessments can include determining whether veterans are suffering from post-traumatic stress disorder or traumatic brain injury or grappling with more day-to-day problems in their lives such as housing or child care, for example.
In reaching out to veterans, Davies noted that her team gets a lot of calls from concerned family members of veterans. Other groups working with Valley veterans also collaborate with the VA Medical Center at times, including the government-sponsored Vets Center in Springfield, local veterans agents and outreach workers from the state Department of Veterans Services.
Christopher McGurk, a U.S. Army veteran from Belchertown who served in Iraq and Afghanistan, is a state outreach coordinator in the Statewide Advocacy for Veterans Empowerment, or SAVE, program. He said he's probably steered about 15 area veterans to services at the VA Medical Center in Leeds during the past six months. But most of those veterans served in Vietnam, not the more recent conflicts in Iraq and Afghanistan, he noted.
"A lot of them still won't admit that they need help," McGurk said, of the younger generation of returning combat veterans. "They're so fresh out of Iraq and Afghanistan. They're still in that initial stage of trying to reintegrate. It's kind of difficult to broach the subject of mental health treatment when they don't want to hear it."
Mental health services
In recent years, the medical center has significantly increased the number of psychologists, social workers and others who provide veterans with mental health services. A staff of 50 people four years ago has mushroomed to more than 90 inpatient and outpatient mental health workers at the Leeds facility and its satellite clinics today, according to figures provided by the medical center. The mental health staff has more than tripled from a decade ago.
Opened in 1924, the VA Medical Center today provides psychiatric, substance abuse and post-traumatic stress disorder services, as well as primary and secondary levels of medical care to veterans in western Massachusetts. The medical center has 85 psychiatric beds and a 66-bed nursing home care unit on its 105-acre campus, as well as a 16-bed transitional residence for substance abusers off campus.
In addition, the hospital is planning a long-rang, multimillion-dollar renovation of its nursing care unit, or Community Living Center, an upgrade said crucial to serving some of the more than 30,000 soldiers wounded in Operations Iraqi Freedom and Enduring Freedom.
The medical center also runs three community-based outpatient clinics in Springfield, Greenfield and Pittsfield. Veterans visiting these clinics as well as the main hospital can now be seen within minutes, according to Dr. Gonzalo Vera, the medical center's director of mental health.
"Access to mental health care is not an issue," Vera said, of the VA's mental health services.
What is changing, Vera noted, is the way veterans' care is being managed. The medical center is implementing an intensive care management program for veterans that brings together an array of case workers serving a particular veteran, and changes in the way veterans are diagnosed and treated. These professionals can include psychologists, social workers, doctors and nurses as well as suicide prevention coordinators who track patients for whom suicide is an issue. The program moves away from the more departmentalized or fragmented care veterans have traditionally received in the VA system, Vera said.
"There are interventions we know are successful," Vera said. "Things that used to not be done are being done now."
The medical center is also expanding its programs to reach out to families of veterans, such as providing counseling services for spouses of veterans to prevent problems and dysfunction down the road.
"We're trying to intervene as early as possible," Vera said. "At least the spouse needs to understand what the (other) spouse has gone through."
The majority of returning combat veterans at the VA Medical Center, including those returning from Iraq and Afghanistan, have mental health problems, but other issues abound.
"There are always readjustment issues even if you don't have PTSD," Vera said. "A lot of (veterans) could use some sort of service to make that changeover."
Women's health
VA medical centers have long been viewed as male-dominated institutions, but a culture change is under way as more attention is being paid to the needs of female veterans who are seeking VA services - and in larger numbers.
"They deserve the same level of access to care," said Paul Rieckhoff, executive director of Iraq and Afghanistan Veterans of America, a veterans advocacy group based in New York.
The group released a report in October that highlighted the pressing issues facing female veterans in the military, including higher rates of sexual assault, harassment and military sexual trauma, higher divorce rates compared to male service members, increasing homelessness and barriers to VA health care, including the fragmentation of services.
The last area is one the VA Medical Center in Leeds is working hard to address and prioritize. As part of a federal mandate designed to improve the care of female veterans, the medical center has hired Dr. Lynn Zashin as its medical director of women's health.
"Now that there are so many more female veterans, the VA is stepping up to the plate and realizing there have been shortcomings in care for women," Zashin said.
For starters, that includes making the VA a more hospitable place for women, from creating more privacy in exam rooms and hiring more female staff to hanging posters of female soldiers and providing more women-oriented magazines in waiting rooms.
"For women to come here, many feel it doesn't look at all like a doctor's office and they don't fit in," Zashin said. "It's really important for us to create an atmosphere that this is their site. The more women are here, the more women will feel comfortable here."
Zashin noted that while male veterans use VA services more than female veterans percentage-wise, the medical center and its satellite clinics are seeing more female veterans today compared to previous generations.
Zashin's job is to ensure the quality of care for female veterans remains high and to spearhead a consolidation of what had long been a very fragmented system of care for female veterans.
The new women's health program coordinates mental health and service-connected care, gender-specific primary care and preventive health services that focus on problems such as cholesterol and diabetes.
"We've tried to bring in services we believe would be used a lot," Zashin said.
Last year, the medical center treated 673 female veterans who served in military operations supporting campaigns in Iraq and Afghanistan, many with mental health problems and others with physical injuries.
"I've seen women who are stressed, who are having trouble settling in," Zashin said. "And, disabled women veterans from Iraq and Afghanistan who are trying to get rehabilitated who were near enough to explosions to be hurt very badly."
Zashin acknowledged that while the medical center's health-care network for women has improved significantly, there is still work to be done.
"I think we are getting closer. I think the quality of care is there but the manner in which (care) is given might not be comfortable enough," she said. "We are creating the culture change right now."
Dan Crowley can be reached at dcrowley@gazettenet.com.
